BUDGET

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58 MEETING OUR GREATEST CHALLENGES: OPPORTUNITY FOR ALL increase rural families’ access to promising and evidence-based programs and services. The Budget makes unprecedented investments in two-generation approaches—aligning high-quality early childhood education for children with high-quality workforce development for parents to put the entire family on a path to educational success and permanent economic security. The Budget provides $20 million for two-generation demonstration projects within USDA to fight rural child poverty and $16 million to support an integrated model for early childhood development and parental involvement for American Indian families in BIE-funded schools. As discussed above, the Budget also introduces a new rural home visiting program that complements HHS’s evidence-based Maternal, Infant, and Early Childhood Home Visiting program to serve more high-risk, high-need children and families in remote rural areas. Promoting Permanency, Safety, and Well- Being for Children and Youth in Foster Care. On any given day, there are more than 400,000 young people in the Nation’s foster care system, with over 100,000 waiting to be adopted. The Budget includes a package of investments designed to do more to prevent the need for foster care and assist children and families so that children can either be reunited with their biological parents or placed in a permanent home where they can thrive. The Budget includes funding to provide critical preventative services to vulnerable families and children to address hardships early, keeping more children out of foster care and with their families, as well as funding to promote family-based care for children with behavioral and mental health needs to reduce the use of congregate care—which can have negative effects on children. The Budget also provides funding to help improve the training and skills of the child welfare workforce, individuals working with some of the most vulnerable children and youth in the Nation, including funding to help caseworkers obtain a Bachelor or Master’s degree in social work and incentivize State child welfare agencies to hire and retain caseworkers with this specialized education. The Budget continues to include funding for Tribes to build their child welfare infrastructure, and for tribal children and youth removed from their homes to remain in their communities. Improving Health Outcomes for Children and Youth in Foster Care. The Budget continues to propose a Medicaid demonstration project in partnership with HHS’s Administration for Children and Families to encourage States to provide evidence-based psychosocial interventions to address the behavioral and mental health needs of children in foster care and reduce reliance on psychotropic medications to improve overall health outcomes. Helping Families Achieve Self-Sufficiency through the Upward Mobility Project. The Budget continues to support the Upward Mobility Project, which would allow up to 10 communities, States, or a consortium of States and communities more flexibility to use funding from up to four Federal programs for efforts designed to implement and rigorously evaluate promising approaches to helping families achieve self-sufficiency, improving children’s education and health outcomes, and revitalizing communities. Projects will have to rely on evidence-based approaches or be designed to test new ideas, and will have a significant evaluation component that will determine whether they meet a set of robust outcomes. The funding streams that States and communities can use in these projects are currently block grants—the Social Services Block Grant, the Community Development Block Grant, the Community Services Block Grant, and the HOME Investment Partnerships Program—that share a common goal of promoting opportunity and reducing poverty, but do not facilitate cross-sector planning and implementation as effectively as they could. The Budget also provides $1.5 billion in additional funding over five years that States and communities can apply for to help support their Upward Mobility Projects.
THE <strong>BUDGET</strong> FOR FISCAL YEAR 2017 59 BUILDING ON THE ACA TO IMPROVE AMERICANS’ HEALTH For decades, too many Americans went without the security of health insurance. Since the ACA’s coverage provisions have taken effect, 17.6 million Americans have gained health insurance coverage through the Health Insurance Marketplace, Medicaid, and other sources. Now, fewer than 1 in 10 Americans lack health insurance for the first time in history. The dramatic decline in the uninsured rate shows the ACA is working, making health care more affordable and accessible for millions of people. The ACA also provides Americans the economic security they deserve. Because of the ACA, American families no longer need to worry about losing coverage due to economic setbacks, such as lay-offs or job changes, or due to pre-existing conditions, such as asthma, cancer, or diabetes. In addition, health insurance plans cannot bill patients into debt because of an illness or injury, or limit annual or lifetime dollar benefits. Americans have benefited from these changes. For example, the number of people in households that faced problems paying medical bills fell by 12 million from 2011 to 2015. Further, the ACA has taken historic and significant steps toward putting the Nation back on a sustainable fiscal course, while laying the foundation for a higher quality health care system. It is improving the quality of care that Americans receive and reducing cost growth by deploying innovative new payment and delivery models that incentivize more efficient, higher-quality care. With the ACA as a solid foundation, the Budget makes additional health care investments and reforms to further improve the Nation’s health care system and the health of all Americans. With approximately $375 billion in health savings that will grow over time, the Budget would extend the exceptionally slow cost growth of recent years. It builds on the dependable health insurance provided to Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries, supports an aggressive agenda to transform the Nation’s health care delivery system into one that better incentivizes quality and efficiency, reins in growing drug costs while improving quality and transparency, and includes proposals that extend the life of the Medicare Hospital Insurance Trust Fund by over 15 years. Implementing the ACA and Improving Health Care in America The Budget fully funds the ongoing implementation of the ACA and makes a number of improvements to the health care system. Supporting Medicaid Expansion. The ACA expanded affordable health insurance coverage to millions of low-income Americans by offering significant Federal financial support to States that expand Medicaid eligibility to non-elderly individuals with income below 133 percent of the poverty line, roughly $26,700 for a family of three. In the 30 States (and the District of Columbia) that expanded Medicaid by the end of 2015, the share of people without health insurance has fallen significantly, along with the cost of uncompensated care. The Budget provides further incentive for States to expand Medicaid by covering the full cost of expansion for the first three years regardless of when a State expands, ensuring equity between States that already expanded and those that will expand in the future. Previously, the ACA covered the full costs through calendar year 2016 before gradually reducing the level of support to 90 percent. Protecting Consumers and Other Reforms. The Budget makes targeted improvements to the ACA’s private insurance programs, including proposals to help eliminate unexpected health care charges and provide for uniform health care billing documents, among other reforms. It also proposes to standardize the definition for American Indians and Alaska Natives used in the ACA. The Budget bolsters program integrity efforts with additional investments and a proposal to allow the Centers for Medicare & Medicaid Services (CMS) access to new data sources to improve the accuracy
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BUDGET OF THE U.S. GOVERNMENT FISCA
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THE BUDGET DOCUMENTS Budget of the
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Page Ensuring Safety, Fairness, and
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THE BUDGET MESSAGE OF THE PRESIDENT
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168 LIST OF CONTRIBUTORS Mark T. Er
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170 LIST OF CONTRIBUTORS Mario Roy
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EXECUTIVE OFFICE OF THE PRESIDENT B
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BUDGET

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